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Investigation and inquest
On the 8ᵗʰ June 2020, I commenced investigations into the deaths of Jennifer BUNYAN, aged 24 years and her mother, Marion BUNYAN aged 54 years. The investigations concluded at the end of an inquest on the 25th May 2023.
The Conclusion of the inquest was Road Traffic Collision.
Circumstances of the death
Jennifer and Marion Bunyan, the driver of, and a passenger in a motor car respectively, died on the 7th June 2020 in a waterway known as Crease Drain, adjacent to the C117, Puddock Road, Warboys.
The cause of their deaths was from drowning when their motor car left the carriageway and travelled over the eastern grass verge where it then descended into the said waterway.
The motor car rolled on to its roof. They were unable to extricate themselves from the vehicle and died as a result of the vehicle being partially submerged in water.
At the time of her death, Jennifer was pregnant (circa 30 weeks gestation), and her unborn daughter, subsequently named Erin Marion Chatten, died in utero.
Coroner’s concerns
CAMBRIDGESHIRE COUNTY COUNCIL
A. SPEED LIMIT
The designated speed for this section of road was 60 mph.
The charity BRAKE have stated that the default speed limit on rural roads is 60 mph, a speed at which it is rarely safe to travel.
They stated the approach should be based on the design of roads. This road has an uneven road surface and it was within local knowledge that the designated speed limit was dangerous and could lead to a loss of control whilst driving in the upper speed range.
The need for a reduction in the limit as a safety measure does not appear to have been raised during inspections/debriefs following a series of fatalities that have led to a number of drowning incidents along this section of road. It raises a concern that the speed limit should be reduced significantly as a risk reduction measure – some areas have adopted 20 mph on some sections of road.
B. INSPECTIONS OF THE ROAD
I have a concern that inspections of the road have not been sufficiently rigorous given a recurring issue of highway degradation from ‘rutting’ at the carriageway edge which can be a contributory factor causing loss of control of a vehicle.
It is unclear if the council have carried out audits to review the quality of inspections and whether there have been examples of substandard inspections.
C. LENGTH OF TIME TO EFFECT REMEDIAL ACTION
These deaths occurred on the 7ᵗʰ June 2020 and there had been previous fatalities along this road which had led to fatalities caused by drowning when vehicles left the road.
A Barrier to prevent entry to the waterway would be one effective measure that has been deployed in many other places to prevent a vehicle leaving the road and yet, I understand no final solution is in place.
D. HIGHWAY DEGRADATION
This has been an issue and I have a concern about prompt repairs being effected to the road and also the weight of vehicles which is a factor in damage to the verge adjacent to the road itself.
E. LOCAL SAFETY GROUP
The Fenland Road Safety Campaign (Charlotte's Way) have undertaken outstanding work as a charity in raising awareness of the dangers of Fenland roads given the unique environmental factors involved. It is not clear whether there has been prompt action taken following representations from them on safety matters.
SECRETARY OF STATE FOR TRANSPORT
A. CLUSTER SITES
Councils have a number of roads that feature on a cluster site analysis. By their nature, these will carry an obvious and serious risk of death or significant injury. Funding pressures in recent years have delayed prompt action in risk reduction at these sites. It raises a question of whether there should be a central government fund as a special measure to release capital for such sites as this would lead to enhanced risk reduction repairs being deployed more quickly.
B. GPS
On the facts of this investigation, this road had seen a number of fatalities which would not be known to those unfamiliar with the area (as here). It raises a question of whether there could be collaboration with software companies to flag roads on satellite navigation programming for providing verbal/visual prompts that a particular road carries high risk as an accident site.
Information checked against the published report and official responses